Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis

Abstract

Sarcoidosis is a multisystem disorder of unknown origin and poorly understood pathogenesis that predominantly affects lungs and intrathoracic lymph nodes and is characterized by the presence of noncaseating granulomatous inflammation in involved organs. The disease is highly heterogeneous and can mimic a plethora of other disorders, making diagnosis a challenge even for experienced physicians. The evolution and severity of sarcoidosis are highly variable: many patients are asymptomatic and their disease course is generally benign with spontaneous resolution. However, up to one-third of patients develop chronic or progressive disease mainly due to pulmonary or cardiovascular complications that require long-term therapy. The diagnosis of sarcoidosis requires histopathological evidence of noncaseating granulomatous inflammation in one or more organs coupled with compatible clinical and radiological features and the exclusion of other causes of granulomatous inflammation; however, in the presence of typical disease manifestations such as Löfgren’s syndrome, Heerfordt’s syndrome, lupus pernio and asymptomatic bilateral and symmetrical hilar lymphadenopathy, the diagnosis can be established with high level of certainty on clinical grounds alone. This review critically examines the diagnostic approach to sarcoidosis and emphasizes the importance of a careful exclusion of alternative diagnoses.

The Onset of Sarcoidosis After COVID-19 Vaccination Revealed by the 18F-FDG PET

“…[7][8][9] Sarcoidosis is a heterogeneous multisystem disease characterized histologically by the manifestation of noncaseating granulomas in concerned organs, especially the bilateral lungs, hila, and mediastinal lymph nodes. 10,11 The mechanism of sarcoidosis is equivocal but gradually unclouded because of the well-known hallmarks of the aberrant immune response triggered by the so far vague antigen, 12 although sarcoidosis, the mimicking master, frequently hides under the cover of cancerous and infectious disease, which usually presents as one single lesion as the case exhibited and easily misguides radiologists to the wrong direction. 11,13 However, it should be noted that 18 F-FDG PET/CT relying on its high sensitivity to metabolic levels of inflammation in the whole body warrants the assessment of the disease extent and confirms the most appropriate site for biopsy if needed.…”

Delineating the CCDC22‐related Ritscher–Schinzel syndrome phenotype in the original family

“…Patient 5 has been diagnosed with sarcoidosis, a multisystem granulomatous disorder that in over 90% of cases involves the lungs (Bernardinello et al, 2021). While to date he is the only individual with a CCDC22 variant reported with sarcoidosis, a CCDC22 polymorphism has been implicated in systemic lupus erythematosus, another condition associated with immune system dysregulation (D'Amico et al, 2017).…”

Sarcoidosis and COVID-19: At the Cross-Road between Immunopathology and Clinical Manifestation

“…Consequently, respiratory symptoms prevail, with dry cough, dyspnea, reduced exercise tolerance, and chest discomfort present in 30–50% of cases [ 51 , 52 ]. Dyspnea is more common in patients with fibrotic lung disease or respiratory tract involvement; however, unlike other interstitial lung diseases, respiratory symptoms may not reflect the severity of the disease extent on chest imaging or functional impairment [ 53 ]. Chronic cough and chest pain are two frequent and significant additional symptoms that can contribute to breathlessness, thus limiting exercise activity.…”